Systematic review of various laser intervention strategies for proliferative diabetic retinopathy

Abstract

Diabetic retinopathy (DR) is a common complication of diabetes. DR obstructs blood supply to the retina and has serious and long-lasting detrimental effects on quality of life. Panretinal photocoagulation, a laser surgical intervention, is advocated for early treatment of DR to prevent visual loss; however, results from studies reporting its efficacy vary markedly. In this review, we systematically conducted a database search of randomized controlled trials that investigated the safety and efficacy of different types of laser interventions, alone or in combination with adjunct intravitreal steroid utilization, in patients with DR. Data from 14 studies demonstrated that panretinal photocoagulation can be a safe and effective option for reducing visual loss and blindness in patients with DR.

Keywords:

• diabetes
• diabetic retinopathy
• panretinal photocoagulation
• systematic review

Financial & competing interests disclosure

This article was supported by National Major Scientific and Technological Special Projects (No. 2011ZX09302-007-02); Natural Science Foundation of China (No. 81273424, No. 81170862); Shanghai Natural Science Foundation (No. 13ZR1433200) and Opening Project of Shanghai Key Laboratory of Fundus Diseases (No. 07Z22911). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Diabetic retinopathy (DR) has serious and long-lasting detrimental effects on quality of life among those with diabetes.

• Photocoagulation laser surgery is considered standard of care in the treatment and prevention of DR; however, results from studies reporting its efficacy vary.

• The safety and efficacy of panretinal photocoagulation for diabetic retinopathy was confirmed in this systematic review.

• There is evidence that adjunctive intravitreal triamcinolone reduces the risks for visual loss and retinal inflammation following panretinal photocoagulation.

• The most common adverse effect reported in these studies was pain.

• Future advances in laser treatment will include lower energy lasers, improved visual surgical guidance systems and the application of additional adjunctive treatments.

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